Diabetes is both a lifelong and a twenty-four hour a day condition. Glucose control is almost entirely in the hands of the person who lives with this condition. His/her motivation to eat, exercise, take medication, test glucose levels, and maintain a normal body weight all vie with life's other motivations.
One of the biggest challenges for health care providers today is how to address the continued needs and demands of individuals with chronic illnesses like diabetes [
1]. Conversely, the challenge for patients is how to obtain the necessary skills to effectively manage their diabetes. Recent research has increased the emphasis on tight metabolic control as several large intervention studies have indicated maintaining good metabolic control can delay or prevent the progression of complications associated with diabetes [
2‐
5]. The introduction of home blood glucose monitors in the 1980's and widespread use of glycosylated haemoglobin as an indicator of metabolic control have also contributed to changes in the approach to diabetes self-care, and thus have shifted more responsibility to the patient [
6]. The advancements in technology and recommendations from these studies are very important and convincing but present health care providers with the challenge of implementing them in practice. A recent qualitative study examining self- monitoring of blood glucose in patients with type 2 diabetes suggests the role of the health professional is crucial to patient understanding of their blood glucose fluctuations and whether or not the patient responds to the high blood glucose reading with an appropriate self-care action [
7]. Diabetes self-care requires the patient to make many dietary and lifestyle changes simultaneously further emphasizing the need for self-care management support. A meta-analysis of self-management education for adults with type 2 diabetes, reported self-management education improves glycaemic control at immediate follow-up, and increased contact time increases the effect [
8]. However, the benefit declines one to three months after the intervention ceases, suggesting that learned behaviours may change over time and continuing education is necessary [
8]. Prescribed regimen changes can also impact the patient, as Bradley
et al. observed: patients reported a higher self-care burden when insulin was added to their regimen [
9]. Williams
et al. found patients who feel their health care provider understands and supports them were more likely to have higher levels of self-confidence resulting in successful behaviour change [
10]. The self-care burden is largely the responsibility of the patient as Glasgow and colleagues emphasize; the patient is the one who must decide which diabetes self-care strategies to practice, and ultimately they experience the results of those self-care actions [
11]. Furthermore, Ockleford
et al. suggests health professionals should tailor their patient self-care support based on the degree of personal responsibility the patient is willing to assume towards their diabetes self-care management [
12]. Patient preferences for group or private self-care management education should also be taken into consideration [
12].
Examining health-related behaviour from a theoretical context may further describe the diabetes self-care decision making process. Several constructs that possibly will help explain the behaviours required for successful diabetes self-care management are: self-efficacy, locus of control, health belief and health value. Self-efficacy is concerned with the perceptions a person has about their ability to perform a task and can influence the acquisition of new behaviours, while locus of control contends with an individual's perception of whether their action determines an outcome or is outside of their control [
13,
14]. Health belief can be influenced by the person's perceptions of the perceived benefits of positive behaviour change, and health value interacts with locus of control to influence health-protective behaviours [
15,
16].
The aim of the present study is to explore patient perceptions of diabetes self-care and to identify different self-care coping strategies among patients using qualitative techniques. Discussion of the patient self-care coping strategies and corresponding patient types is made in the theoretical context of the health belief, health value, self-efficacy, and locus of control frameworks to help illustrate the findings within the context of applied health science.